Today 200,000 Ugandans need anti-retroviral
drugs to fight the Aids virus. But only 'between 12,000 and 17,000
are getting them', said Stephen Lewis, the United Nations special
envoy on Aids, speaking in Uganda last week. 'The intellectual
property debate is rendering human rights subsidiary to human
greed.'

Rows over access to life-saving medicine
were supposed to have been laid to rest in the wake of 11 September,
when the US was desperate to build an international coalition
against terrorism. It appeared to have one, partly thanks to
a short statement by world trade ministers in November 2001 -
the Doha declaration - which confirmed that public health superseded
intellectual property rights.

What has blocked the deal is the reluctance
of drug firms to allow countries unable to manufacture cheap
copies of brand name medicines to import them from countries
which can make them.

Not a single poverty-stricken country has
been able to do this. Agreement between drug firms, Western governments
and developing nations on allowing them to do so was scheduled
to have been reached last December.

Last week, Robert Mallett, a senior executive
with Pfizer, the world's biggest drug firm, told The Observer
that Indian generic drug manufacturers were using the row for
their own commercial ends.

It also emerged that as a condition of
ratifying a new intellectual property treaty, known as Trips
- which would allow the issuing of compulsory licences - major
drugs firms want to force China, Brazil and India to stop producing
cheap copies of brand name drugs.

'This is a nightmare catch-22,' said Mohga
Kamal Smith, Oxfam's health policy adviser. 'Without the capacity
to manufacture drugs, developing countries won't be able to find
a country prepared to export them. There's a scandalous double
standard at work here. Poor countries are punished for not having
the capacity to produce drugs.'

For decades, 'big pharma' has fought to
limit the scope of countries to import cheap copies of its patented
drugs. In the post-industrial age, patents are the most valuable
commodity a company has and are jealously guarded.

Drug firms argue that generic producers
compromise the research and development of drugs, that there
is a risk that cheap drugs could leak back into Western healthcare
systems and that poor countries' health systems need to be robust,
with more money devoted to health provision.

Critics say that huge amounts of public
money go into researching cures for diseases, that developing
countries account for a minuscule proportion of drug firms' turnover
and that drug 'leakage' is easily controllable.

Campaigners point to the influence of leading
drug firms - during the last Presidential election, they contributed
$14 million to George Bush's campaign and there are 625 lobbyists
on Capitol Hill hired by pharmaceutical companies, more than
the number of Congressman.

Although the US seems to have been the
biggest stumbling block to agreement post-Doha, the UK Government
has lobbied for years against legitimising access to cheap generic
copies.

Negotiations have recently centred on the
offer to allow the provision of generic drugs to treat a limited
number of diseases. This was rejected by poor countries since
most of the diseases did not have any patented drugs to counter
them. Negotiations have subsequently shifted to poverty-stricken
countries, citing national emergency as the trigger to win the
right toimport generics.

'You only have to look at the economic
implications of citing national emergency in the wake of the
Sars outbreak to know that this could cause even more problems,'
said Nathan Ford of Médecins sans Frontières. A
declaration of national emergency is assumed to have wider negative
economic implications, such as a boycott by tourists and a disappearance
of investment.

Negotiations in Canada between the world's
trade ministers last week got nowhere. The talks are aimed at
finding a solution before the world trade talks in Cancun, Mexico,
next month.

Cancun is meant to secure access to restricted
Western markets for developing countries' products. It could
also see developing countries forced to privatise their utilities.
But for the talks to have a chance of success, the drugs issue
- as well as some agricultural disputes - has to be resolved.

Developing countries are still under huge
pressure to relent on their demand for generic drugs and trade
sanctions have been deployed againstnations producing cheap copies.
But many now point to George Bush's promise of $15bn to fight
Aids in Africa as a major breakthrough.

However, the programme still has to be
passed by Congress - and the majority of funds will not be forwarded
to the UN's global fund on Aids. There are fears that it might
be used to secure bilateral trade agreements between the US and
poor countries.

The UN's Lewis said: 'There's a desperate
need to keep people alive. There's no justification for not doing
so. One of the keys is anti-retrovirals. Therefore I understand
the need to give people sweeping access to generic drugs for
a long period of time. I don't think one can settle on short-term
arrangements.'

The arguments over access to drugs are
simple. The world agreed in November 2001 that health should
take priority over patents. But with millions dying, drug companies
and Western governments seem to have muddied the waters.